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. 2018 Dec 14;2018(12):CD011710. doi: 10.1002/14651858.CD011710.pub2

Krupnick 2017.

Study characteristics
Methods Randomised controlled trial
Participants Sample size: 34
Diagnosis: DSM‐IV PTSD
Method of recruitment: clinician referral
Method of diagnosis: PCL‐M with cut‐off score 50
Trauma type: military
Age (mean): WIRED: 35.44 years; WIRED+TAU: 44.75 years (SDs not reported)
Sex: 8.8% women; 91.2% men
Location: US
Comorbidities: no structured screening for comorbid conditions
Adjunctive therapy: a chart review revealed that several participants received adjunctive treatment.
Adjunctive medication: 50%
Unemployment: not reported
University education: not reported
Exclusion criteria: current substance dependence, acute suicidality, psychosis, gross cognitive impairment, current participation in CBT
Baseline PCL‐M scores (mean item score): WIRED: 3.6 (SD 0.3); WIRED+TAU: 3.9 (SD 0.4)
Interventions Internet programme based on trauma‐focused CBT versus treatment as usual
Experimental arm
WIRED (based on Interapy)
Duration: 10 sessions
Treatment protocol
  • 10 writing sessions (adapted from Interapy).

  • First 4 sessions confronted the trauma.

  • Next 4 focused on cognitive restructuring of maladaptive thoughts about the experience.

  • Final 2 sessions emphasises leave‐taking and social sharing.


Therapist contact: as required. A short response and further instructions sent after each writing session.
Type of contact: online
Automated contact: none
Type of therapist: psychologist
Treatment fidelity: unclear
Comparator arm
TAU
  • A chart review after completion of the study showed that 4 participants began and 1 completed a course of cognitive processing therapy.

  • 8 participants received antidepressant medication.

  • 1 participant received 13 sessions of acupuncture.

Outcomes PCL‐M (mean item scores); PHQ‐9 (could not be entered into meta‐analysis)
Notes Funding source: grant from Telemedicine and Advanced Technology Research Center, U.S. Department of Defense.
Declarations of interest among the primary researchers: unclear
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not reported
Allocation concealment (selection bias) Unclear risk Not reported
Blinding of participants and personnel (performance bias)
All outcomes High risk Impossible to blind participants or therapists.
Blinding of outcome assessment (detection bias)
All outcomes Low risk All measures administered after baseline were self‐reported and completed online.
Incomplete outcome data (attrition bias)
All outcomes High risk Dropout rate > 75%. Reasons for dropout not fully reported.
Selective reporting (reporting bias) Low risk Study protocol not available but it was clear that the published reports included all expected outcomes, including those that were prespecified.
Other bias High risk Small sample size. Participants received other interventions during the trial.